Provider Demographics
NPI:1487749784
Name:SMIDT, JEFFREY JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAMES
Last Name:SMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2625
Mailing Address - Country:US
Mailing Address - Phone:952-224-5717
Mailing Address - Fax:
Practice Address - Street 1:9740 IRVING AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2625
Practice Address - Country:US
Practice Address - Phone:952-224-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor